Merged in hotfix/methodology_breakout_issue_fixes (pull request #456)
Hotfix/methodology breakout issue fixes * Merge branch 'hotfix/methodology_breakout_issue_fixes' of https://bitbucket.org/aarete/doczy.ai into hotfix/methodology_breakout_issue_fixes merged with current local changes * opps methodology added * Merge branch 'main' into hotfix/methodology_breakout_issue_fixes * Merge branch 'main' into hotfix/methodology_breakout_issue_fixes merged changes from main * Merged main into hotfix/methodology_breakout_issue_fixes * duplicate N/A fixed * Merge branch 'hotfix/methodology_breakout_issue_fixes' of https://bitbucket.org/aarete/doczy.ai into hotfix/methodology_breakout_issue_fixes merged changes from main * updated AARETE_DERIVED_REIMB_METHOD prompt * fee schedule prompt change * REIMB_PCT_RATE prompt updated * Merged main into hotfix/methodology_breakout_issue_fixes * opps moved to grouper * fee rate format fixed * removed incentives * removed funding and additional reimbursement * separate invalid reimb * Merge branch 'main' into hotfix/methodology_breakout_issue_fixes * merged main into current branch * updated valid reimb and fee_schedule_version * code structure fix * code structure fix 2 * Merge branch 'main' into hotfix/methodology_breakout_issue_fixes * updated methodology breakout fields * test notebook updated * Merged main into hotfix/methodology_breakout_issue_fixes Approved-by: Katon Minhas
This commit is contained in:
Mayank Aamseek
committed by
Alex Galarce
Alex Galarce
parent
e3cd8372de
commit
6f1d7d90b4
@@ -45,18 +45,17 @@ VALID_PROV_TYPE = [
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VALID_AARETE_DERIVED_FEE_SCHEDULE = [
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"CMS", "Medicare",
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"State", "Medicaid",
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"Health Plan", "Proprietary"
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"CMS",
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"State",
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"Health Plan",
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"AWP",
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"WAC",
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"ASP"
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]
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VALID_AARETE_DERIVED_FEE_SCHEDULE_VERSION = [
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"current",
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"in effect on the date of service",
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"unspecified",
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"then-current",
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"year prior",
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"most current"
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"year prior"
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]
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VALID_CLAIM_TYPE = [
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@@ -74,21 +73,25 @@ VALID_REIMB_TERM = [
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"Per Diem", # claim level
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"Case Rate", # multiple claim level
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# "MedRx",
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"AWP", # will be converted to MedRx in postprocessing
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"ASP", # will be converted to MedRx in postprocessing
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"WAC", # will be converted to MedRx in postprocessing
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"Cost Plus",
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"Pass Through",
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# "Pass Through",
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"Grouper",
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"Outlier",
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"Stop-Loss",
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"Reductions",
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"RBRVS",
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"RVU",
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# "Outlier",
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# "Stop-Loss",
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# "Reductions"
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# "DOFR", # moved to prompt as this value is rare
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]
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# these reimbursement methods will be removed in postprocessing.
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INVALID_REIMB_TERM = [
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"Incentive Payment",
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"Funding",
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"incremental/ additional reimbursement"
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# "Medicare Member Cost Share" # This is a special case where the member is responsible for the cost share and these records will be removed in postprocessing. moved to prompt as this value is rare.
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]
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VALID_REIMB_TERM_FULL = VALID_REIMB_TERM + INVALID_REIMB_TERM
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VALID_CARVEOUTS = {
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"DEFAULT_TERM" : "Describes the default payment for when there is no established payment amount on the fee schedule or elsewhere.",
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"UNLISTED_CODE" : "Describes payments for codes that are not listed on a fee schedule. This is similar to DEFAULT_TERM. Only populate with Y if the Service or Methodology specifically mentions Codes.",
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@@ -258,16 +258,8 @@ def postprocess(df):
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"AARETE_DERIVED_TERMINATION_DT"
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] = "9999/01/01"
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# Remove rows where 'AARETE_DERIVED_REIMB_METHOD' value is "Medicare Member Cost Share"
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df = df[df['AARETE_DERIVED_REIMB_METHOD'] != "Medicare Member Cost Share"]
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# Standardize 'AARETE_DERIVED_REIMB_METHOD' values
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# Copy AWP, ASP, WAC to AARETE_DERIVED_FEE_SCHEDULE column for the corresponding row
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medrx_fee_schedule_values = ['AWP', 'ASP', 'WAC']
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df.loc[df['AARETE_DERIVED_REIMB_METHOD'].isin(medrx_fee_schedule_values), 'AARETE_DERIVED_FEE_SCHEDULE'] = df['AARETE_DERIVED_REIMB_METHOD']
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# Convert AARETE_DERIVED_REIMB_METHOD values [AWP, ASP, WAC] to 'MedRx'
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df['AARETE_DERIVED_REIMB_METHOD'] = df['AARETE_DERIVED_REIMB_METHOD'].replace({'AWP': 'MedRx', 'ASP': 'MedRx', 'WAC': 'MedRx'})
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# remove and update aarete_derived_reimbursements
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df = postprocessing_funcs.remove_update_reimbursement(df)
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# Add reimb_id
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df = postprocessing_funcs.generate_reimb_ids(df)
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@@ -6,6 +6,7 @@ import numpy as np
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import pandas as pd
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import src.constants.valid as valid
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import src.constants.investment_values as investment_values
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from src.prompts import postprocessing_prompts
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from src.prompts import investment_prompts
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from functools import cache
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@@ -1130,6 +1131,12 @@ def convert_to_us_date_format(date_str: str) -> str: # postprocessing_funcs.py
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# Raise an exception if the month or day is out of range
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raise InvalidDateException(f"Invalid date format: {date_str}")
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def remove_update_reimbursement(df):
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# Remove rows where 'AARETE_DERIVED_REIMB_METHOD' value is "Medicare Member Cost Share" or "Incentive Payment"
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df = df[~df['AARETE_DERIVED_REIMB_METHOD'].isin(["Medicare Member Cost Share"] + investment_values.INVALID_REIMB_TERM)]
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return df
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def remove_unnamed_columns(df): # postprocessing_funcs.py
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return df[[col for col in df.columns if "Unnamed" not in col]]
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@@ -27,8 +27,8 @@
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"field_name": "AARETE_DERIVED_REIMB_METHOD",
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"relationship": "one_to_n",
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"field_type": "methodology_breakout",
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"prompt": "What is the method of reimbursement? Choose only from the following: {valid_values}.\nFollow these rules:\n- If Average Sales Price (ASP) is mentioned, return 'ASP'\n- For mixed methodologies (e.g., 'cost plus 5% based on AWP'), prioritize the base method (AWP)\n- Use 'DOFR' only when this exact term appears\n- Use 'Medicare Member Cost Share' only when this exact phrase appears\nImportant exceptions:\n- Reimbursements with specific dollar values cannot be 'Fee Schedule'\n- Provider interest rates are not considered 'Flat Rate'",
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"valid_values": "VALID_REIMB_TERM"
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"prompt": "What is the method of reimbursement? Choose only from the following: {valid_values}.\nFollow these rules:\n- If any of Average Sales Price (ASP), AWP (Average Wholesale Price), WAC (Wholesale Acquisition Cost), RBRVS (Resource-Based Relative Value Scale) or RVU (Relative Value Unit) is mentioned, return 'Fee Schedule'\n- In case of MS-DRG, AP-DRG, APR-DRG, APG, EAPG, APC/ OPPS or ASC, return 'Grouper'\n- For mixed methodologies (e.g., 'cost plus 5% based on AWP'), prioritize the base method (AWP)\n- Use 'DOFR' only when this exact term appears\n- Use 'Medicare Member Cost Share' only when this exact phrase appears\nImportant exceptions:\n- Reimbursements with specific dollar values cannot be 'Fee Schedule'\n- Provider interest rates are not considered 'Flat Rate'. \n- ASA is not a reimbursement method and not a fee schedule.",
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"valid_values": "VALID_REIMB_TERM_FULL"
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},
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{
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"field_name": "UNIT_OF_MEASURE",
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@@ -46,7 +46,7 @@
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"field_name": "REIMB_PCT_RATE",
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"relationship": "one_to_n",
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"field_type": "methodology_breakout",
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"prompt": "If the reimbursement rate is a percentage of something, what is that percentage?. If no specific percentage is explicitly mentioned, return 100 as the default value. Extract only the final percentage value from the text."
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"prompt": "If the rate of reimbursement is a percentage of something, what is that percentage rate of reimbursement?. If no specific percentage is explicitly mentioned, return 100 as the default value. Extract only the final percentage value from the text."
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},
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{
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"field_name": "REIMB_EFFECTIVE_DT",
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@@ -78,13 +78,13 @@
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"field_name": "FEE_SCHEDULE",
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"relationship": "one_to_n",
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"field_type": "fee_schedule_breakout",
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"prompt": "Write the full name of the Fee Schedule here. CHIP and STAR are not fee schedules. Only use exact text from the methodology."
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"prompt": "Write the full name of the Fee Schedule here. Include the secondary part of the fee schedule such as clinical lab, outpatient imaging, DMEPOS, encounter, surgeon, clinical diagnostic lab, parenteral and enteral nutrition (PEN), ASC, Part B Drug, Behavioral health, obstetrical, dental, transportation, etc. CHIP and STAR are not fee schedules. Only use exact text from the methodology."
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},
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{
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"field_name": "AARETE_DERIVED_FEE_SCHEDULE",
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"relationship": "one_to_n",
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"field_type": "fee_schedule_breakout",
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"prompt": "What type of fee schedule is it? Choose ONLY from the following: {valid_values}. If a fee schedule is mentioned but doesn't match any values in the list, write 'UNKNOWN'. If no fee schedule is mentioned at all, write 'N/A'.",
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"prompt": "What type of fee schedule is it? Choose from the following: {valid_values}. Along with it, also mention the secondary part of the fee schedule such as clinical lab, outpatient imaging, DMEPOS, encounter, surgeon, clinical diagnostic lab, parenteral and enteral nutrition (PEN), ASC, Part B Drug, Behavioral health, obstetrical, dental, transportation, etc. In case of Medicare, return 'CMS'. In case of Medicaid, return 'State'. In case of Proprietary, return 'Health Plan'. If fee schedule is not mentioned, write 'N/A'.",
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"valid_values" : "VALID_AARETE_DERIVED_FEE_SCHEDULE"
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},
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{
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@@ -97,7 +97,7 @@
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"field_name": "AARETE_DERIVED_FEE_SCHEDULE_VERSION",
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"relationship": "one_to_n",
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"field_type": "fee_schedule_breakout",
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"prompt": "Identify the version of the fee schedule by following these steps in order:\n\n1. Look for explicit version indicators:\n • Version numbers (e.g., 'Version 5.2')\n • Specific years (e.g., '2023')\n • Specific dates (e.g., 'January 2023')\n • Descriptive terms like 'prevailing', 'current', or similar\n\n2. If found, return the exact version indicator as it appears in the text.\n\n3. If multiple indicators are found, prioritize in this order:\n • Explicit version numbers\n • Years/dates\n • Descriptive terms\n\n4. If no explicit version is found but terms like 'prevailing' or 'current' appear, return 'current'.\n\n5. If no version indicators are found, choose ONLY from the following standardized values: {valid_values}.\n\n6. If nothing related to version is mentioned, return 'N/A'.\n\nExamples:\n• '2023 Medicare Fee Schedule' → return '2023'\n• 'prevailing CMS rates' → return 'current'\n• 'Version 5.2 Fee Schedule' → return '5.2'",
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"prompt": "Identify the version of the fee schedule by following these steps in order:\n\n1. Look for explicit version indicators:\n • Version numbers (e.g., 'Version 5.2')\n • Specific years (e.g., '2023')\n • Specific dates (e.g., 'January 2023')\n • Descriptive terms like 'prevailing', 'current', or similar\n\n2. If found, return the exact version indicator as it appears in the text.\n\n3. If multiple indicators are found, prioritize in this order:\n • Explicit version numbers\n • Years/dates\n • Descriptive terms\n\n4. If no explicit version is found but terms like 'prevailing', 'in effect on the date of service', 'unspecified', 'then-current', 'most current' or 'current' appear, return 'current'.\n\n5. If no version indicators are found, choose ONLY from the following standardized values: {valid_values}.\n\n6. If nothing related to version is mentioned, return 'N/A'.\n\nExamples:\n• '2023 Medicare Fee Schedule' → return '2023'\n• 'prevailing CMS rates' → return 'current'\n• 'Version 5.2 Fee Schedule' → return '5.2'",
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"valid_values" : "VALID_AARETE_DERIVED_FEE_SCHEDULE_VERSION"
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},
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{
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@@ -44,537 +44,144 @@
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},
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{
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"cell_type": "code",
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"execution_count": 7,
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"execution_count": 3,
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"metadata": {},
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"outputs": [
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{
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"name": "stdout",
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"output_type": "stream",
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"text": [
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"(3284, 84)\n",
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"(332, 84)\n"
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"(4434, 125)\n",
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"(4434, 125)\n",
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"(10, 125)\n"
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]
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},
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{
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"data": {
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"text/html": [
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"<div>\n",
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"<style scoped>\n",
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" .dataframe tbody tr th:only-of-type {\n",
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" vertical-align: middle;\n",
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" }\n",
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"\n",
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" .dataframe tbody tr th {\n",
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" vertical-align: top;\n",
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" }\n",
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"\n",
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" .dataframe thead th {\n",
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" text-align: right;\n",
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" }\n",
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"</style>\n",
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"<table border=\"1\" class=\"dataframe\">\n",
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" <thead>\n",
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" <tr style=\"text-align: right;\">\n",
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" <th></th>\n",
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" <th>FILE_NAME</th>\n",
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" <th>SERVICE_TERM</th>\n",
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" <th>CARVEOUT_IND</th>\n",
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" <th>REIMB_TERM</th>\n",
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" </tr>\n",
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" </thead>\n",
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" <tbody>\n",
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" <tr>\n",
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" <th>517</th>\n",
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" <td>2018 09 01 UTMB (Amendment 10 change in reimbu...</td>\n",
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" <td>Stop Loss</td>\n",
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" <td>N</td>\n",
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" <td>When Billed Charge is equal to or greater than...</td>\n",
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" </tr>\n",
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" <tr>\n",
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" <th>1883</th>\n",
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" <td>2014-01-01 COMM PPO - PeaceHealth Multi TIN - ...</td>\n",
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" <td>Medicare Part B Drugs (including Injectables a...</td>\n",
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" <td>N</td>\n",
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" <td>One hundred thirty percent (130%) of the then-...</td>\n",
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" </tr>\n",
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" <tr>\n",
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" <th>2221</th>\n",
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" <td>2014-01-01 COMM PPO - PeaceHealth Multi TIN - ...</td>\n",
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" <td>Medicare Part B Drugs (including Injectables a...</td>\n",
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" <td>N</td>\n",
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" <td>One hundred thirty percent (130%) of the then-...</td>\n",
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" </tr>\n",
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" </tbody>\n",
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"</table>\n",
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"</div>"
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],
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"text/plain": [
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"(197, 4)"
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" FILE_NAME \\\n",
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"517 2018 09 01 UTMB (Amendment 10 change in reimbu... \n",
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"1883 2014-01-01 COMM PPO - PeaceHealth Multi TIN - ... \n",
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"2221 2014-01-01 COMM PPO - PeaceHealth Multi TIN - ... \n",
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"\n",
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" SERVICE_TERM CARVEOUT_IND \\\n",
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"517 Stop Loss N \n",
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"1883 Medicare Part B Drugs (including Injectables a... N \n",
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"2221 Medicare Part B Drugs (including Injectables a... N \n",
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"\n",
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" REIMB_TERM \n",
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"517 When Billed Charge is equal to or greater than... \n",
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"1883 One hundred thirty percent (130%) of the then-... \n",
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"2221 One hundred thirty percent (130%) of the then-... "
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]
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},
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"execution_count": 7,
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"execution_count": 3,
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"metadata": {},
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"output_type": "execute_result"
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}
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],
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"source": [
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"labels_df = pd.read_csv('src/testbed/inv-test-0318-RESULTS.csv')\n",
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"labels_df = pd.read_csv('src/testbed/inv-test-0325-RESULTS.csv')\n",
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"print(labels_df.shape)\n",
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"# labels_df = labels_df[labels_df[\n",
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"# 'FILE_NAME'].isin([\"2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt\"\n",
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"# , \"Custom_2020-01-01 Com Affinity Amend FE - St Charles Health System MU.txt\"\n",
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"# ])]\n",
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"print(labels_df.shape)\n",
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"\n",
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"labels_df = labels_df[labels_df[\n",
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" 'CONTRACT_FILE_NAME'].isin([\"2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt\"])]\n",
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" 'REIMB_TERM'].isin([\"When Billed Charge is equal to or greater than the catastrophic threshold of three hundred thousand dollars ($300,000) for a particular confinement, then the entire reimbursement will be paid at forty-seven percent (47%) of Billed Charges (first dollar stop loss).\"\n",
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" , \"One hundred thirty percent (130%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).\"\n",
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" # , \"Health Net will offer $1,000,000 incremental reimbursement for the Medi-Cal line of business each year of the two year renewal effective 5/1/18 and 5/1/19, resulting in an additional $1M reimbursement from 5/1/18 through 4/30/19 and an additional $2M reimbursement from 5/1/19 through 4/30/20.\"\n",
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" ])]\n",
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"print(labels_df.shape)\n",
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"\n",
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"labels_df= labels_df.rename(columns = {\"CONTRACT_SERVICE_CD_OR_DESC\": \"SERVICE_TERM\",\n",
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" \"CONTRACT_CARVEOUT_IND\": \"CARVEOUT_IND\",\n",
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" \"CONTRACT_REIMBURSEMENT_METHOD\": \"REIMB_TERM\"})\n",
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"\n",
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"labels_df_for_prediction = labels_df[[\"CONTRACT_FILE_NAME\", \"SERVICE_TERM\", \"CARVEOUT_IND\", \"REIMB_TERM\"]]\n",
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"labels_df_for_prediction = labels_df[[\"FILE_NAME\", \"SERVICE_TERM\", \"CARVEOUT_IND\", \"REIMB_TERM\"]]\n",
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"labels_df_unique_rows = labels_df_for_prediction.drop_duplicates()\n",
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"labels_df_unique_rows.shape"
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"labels_df_unique_rows"
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]
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},
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{
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"cell_type": "code",
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"execution_count": 8,
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"execution_count": 4,
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"metadata": {},
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"outputs": [
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{
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"name": "stdout",
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"output_type": "stream",
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"text": [
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"Fee Schedule breakout\n",
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"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Payment rates set forth in Exhibit B-P'}\n",
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"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Payment rates set forth in Exhibit B-P', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
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"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of the rates set forth in this Exhibit or 100% of Providers' billed charges. Inpatient rate determination will utilize the Conversion Factor stated above multiplied by the 10-1-13 MS-DRG table weight (version 31), including adjustment for transfers. The 10-1-13 MS-DRG table weights will be used for the contract term 1-1-14 to 12-31-14. If a MS-DRG from the 10/1/13 table splits into new MS-DRG on 10/1/14 (Version 32), the weight from the 10/1/13-DRG table will be applied to the new MS-DRGs.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of the rates set forth in this Exhibit or 100% of Providers' billed charges. Inpatient rate determination will utilize the Conversion Factor stated above multiplied by the 10-1-13 MS-DRG table weight (version 31), including adjustment for transfers. The 10-1-13 MS-DRG table weights will be used for the contract term 1-1-14 to 12-31-14. If a MS-DRG from the 10/1/13 table splits into new MS-DRG on 10/1/14 (Version 32), the weight from the 10/1/13-DRG table will be applied to the new MS-DRGs.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Grouper', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of the rates set forth in this Exhibit or 100% of Providers' billed charges. Inpatient rate determination will utilize the Conversion Factor stated above multiplied by the 10-1-13 MS-DRG table weight (version 31), including adjustment for transfers. The 10-1-13 MS-DRG table weights will be used for the contract term 1-1-14 to 12-31-14. If a MS-DRG from the 10/1/13 table splits into new MS-DRG on 10/1/14 (Version 32), the weight from the 10/1/13-DRG table will be applied to the new MS-DRGs.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Stop Loss Provision', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'Threshold: 200% of Compensation Rate, as applicable. Percent Allowed Above Threshold: 92.5% of Billed Charges. When inpatient charges exceed the Threshold, two hundred- percent (200%) of the amount in excess of the Threshold is allowed in addition to the applicable Case Rate.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Stop Loss Provision', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'Threshold: 200% of Compensation Rate, as applicable. Percent Allowed Above Threshold: 92.5% of Billed Charges. When inpatient charges exceed the Threshold, two hundred- percent (200%) of the amount in excess of the Threshold is allowed in addition to the applicable Case Rate.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Case Rate', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Stop Loss Provision', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'Threshold: 200% of Compensation Rate, as applicable. Percent Allowed Above Threshold: 92.5% of Billed Charges. When inpatient charges exceed the Threshold, two hundred- percent (200%) of the amount in excess of the Threshold is allowed in addition to the applicable Case Rate.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Outlier', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '92.5', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Bariatric Surgery-Exempt from MS-DRGs:619-621', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $18,000 Case Rate or 100% of Providers' billed charges\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Bariatric Surgery-Exempt from MS-DRGs:619-621', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $18,000 Case Rate or 100% of Providers' billed charges\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Case Rate', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 18000, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Bariatric Surgery-Exempt from MS-DRGs:619-621', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $18,000 Case Rate or 100% of Providers' billed charges\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': None, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Re-admission of a Member', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Readmission for the same, similar or related condition which occurs within forty-eight (48) hours of discharge from the same Provider is considered a continuation of initial treatment. The two Provider stays will be consolidated into one, combining all necessary codes, billed charges and length of stay.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Re-admission of a Member', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Readmission for the same, similar or related condition which occurs within forty-eight (48) hours of discharge from the same Provider is considered a continuation of initial treatment. The two Provider stays will be consolidated into one, combining all necessary codes, billed charges and length of stay.'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': \"MS-DRG's :003, 004 and 789-794\", 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of 95.25% of Billed Charges or 100% of Providers' billed charges\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': \"MS-DRG's :003, 004 and 789-794\", 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of 95.25% of Billed Charges or 100% of Providers' billed charges\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 95.25, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': \"MS-DRG's :003, 004 and 789-794\", 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of 95.25% of Billed Charges or 100% of Providers' billed charges\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'All Other Covered Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $24,500 Conversion Factor multiplied by the 10-1-13 MS-DRG table weight (version 31), including adjustment for transfers, or 100% of Providers' billed charges\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'All Other Covered Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $24,500 Conversion Factor multiplied by the 10-1-13 MS-DRG table weight (version 31), including adjustment for transfers, or 100% of Providers' billed charges\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Grouper', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 24500, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'All Other Covered Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $24,500 Conversion Factor multiplied by the 10-1-13 MS-DRG table weight (version 31), including adjustment for transfers, or 100% of Providers' billed charges\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Bariatric Surgery-Exempt from MS-DRGs:619-621', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$18,000 Case Rate'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Bariatric Surgery-Exempt from MS-DRGs:619-621', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$18,000 Case Rate', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Case Rate', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 18000, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': 'N', 'REIMB_TERM': \"The lesser of 359.6% of Medicare or 100% of Providers' billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': 'N', 'REIMB_TERM': \"The lesser of 359.6% of Medicare or 100% of Providers' billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 359.6, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': 'N', 'REIMB_TERM': \"The lesser of 359.6% of Medicare or 100% of Providers' billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': 'N', 'REIMB_TERM': \"The lesser of 388.7% of Medicare or 100% of Providers' billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': 'N', 'REIMB_TERM': \"The lesser of 388.7% of Medicare or 100% of Providers' billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 388.7, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': 'N', 'REIMB_TERM': \"The lesser of 388.7% of Medicare or 100% of Providers' billed charges. Medicare Outpatient Prospective Payment System (OPPS) Methodology using appropriate Tables and Schedules in effect on the date of service, including outlier payments and with GPCI and wage index adjustments.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1, Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: [conversion factor not provided in the text]\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1, Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: [conversion factor not provided in the text]\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1, Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of: [conversion factor not provided in the text]\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1, Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of:\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1, Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of:\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1, Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of:\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 85.0, 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 85.0, 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00. Laboratory services without an RBRVS weight will be allowed at 130% of the 2013 Medicare Clinical Diagnostic Lab Fee Schedule available as of January I, 2013\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00. Laboratory services without an RBRVS weight will be allowed at 130% of the 2013 Medicare Clinical Diagnostic Lab Fee Schedule available as of January I, 2013\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00. Laboratory services without an RBRVS weight will be allowed at 130% of the 2013 Medicare Clinical Diagnostic Lab Fee Schedule available as of January I, 2013\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '85.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00. Laboratory services without an RBRVS weight will be allowed at 130% of the 2013 Medicare Clinical Diagnostic Lab Fee Schedule available as of January I, 2013\", 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '130', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Medicare Clinical Diagnostic Lab Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'Medicare', 'FEE_SCHEDULE_VERSION': '2013', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': '2013'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $85.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 85.0, 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $52.50 Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $52.50 Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $52.50 Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Service', 'REIMB_FEE_RATE': '52.50', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $52.50 Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\", 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RVU', 'UNIT_OF_MEASURE': 'Per 15 minutes', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Mid Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Eighty five percent (85%) of the contract allowable. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Mid Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Eighty five percent (85%) of the contract allowable. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 85, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted Procedures and/or Supplies', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Eighty percent (80%) of billed charges for medically necessary supplies or unlisted procedures (a procedure without a Relative Value Unit).'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted Procedures and/or Supplies', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Eighty percent (80%) of billed charges for medically necessary supplies or unlisted procedures (a procedure without a Relative Value Unit).'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hearing Aids', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"100% of billed charges, not to exceed $4,000.00. Outstanding balance can be billed to member in accordance with the Member's applicable health benefit plan.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hearing Aids', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"100% of billed charges, not to exceed $4,000.00. Outstanding balance can be billed to member in accordance with the Member's applicable health benefit plan.\", 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 4000.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hearing Aid Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Reimbursed using the Medicine Conversion Factor (see Fee Schedule under C this Exhibit) and are subject to any Hearing Aid benefit limitation.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hearing Aid Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Reimbursed using the Medicine Conversion Factor (see Fee Schedule under C this Exhibit) and are subject to any Hearing Aid benefit limitation.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Medicine Conversion Factor', 'AARETE_DERIVED_FEE_SCHEDULE': 'Health Plan', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred and thirty percent (130%) of the Medicare Average Sales Price (ASP) in effect as of January 1, 2013. ODS will not implement Medicare quarterly updates. In the event there is no Medicare ASP, reimbursement will be based on the Wholesale Acquisition Cost (WAC) available as of January 1, 2013 for injectable drugs billed using HCPCS, J-codes, and Q-codes.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred and thirty percent (130%) of the Medicare Average Sales Price (ASP) in effect as of January 1, 2013. ODS will not implement Medicare quarterly updates. In the event there is no Medicare ASP, reimbursement will be based on the Wholesale Acquisition Cost (WAC) available as of January 1, 2013 for injectable drugs billed using HCPCS, J-codes, and Q-codes.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'ASP', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 130, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred and thirty percent (130%) of the Medicare Average Sales Price (ASP) in effect as of January 1, 2013. ODS will not implement Medicare quarterly updates. In the event there is no Medicare ASP, reimbursement will be based on the Wholesale Acquisition Cost (WAC) available as of January 1, 2013 for injectable drugs billed using HCPCS, J-codes, and Q-codes.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'WAC', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'Y', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. ODS will not implement Medicare quarterly updates. For rental DME, ODS requires that the purchase price be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period of DME as defined by CMS.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. ODS will not implement Medicare quarterly updates. For rental DME, ODS requires that the purchase price be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period of DME as defined by CMS.', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 105, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '2013 Medicare DMEPOS schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'Medicare', 'FEE_SCHEDULE_VERSION': '2013', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': '2013'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. ODS will not implement Medicare quarterly updates. For rental DME, ODS requires that the purchase price be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period of DME as defined by CMS.', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery - Secondary procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Secondary procedures performed on the same day as primary procedures and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for the procedure. Any subsequent procedures performed on the same day as the primary procedure and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for those procedures.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery - Secondary procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Secondary procedures performed on the same day as primary procedures and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for the procedure. Any subsequent procedures performed on the same day as the primary procedure and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for those procedures.'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery - Secondary procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Secondary procedures performed on the same day as primary procedures and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for the procedure.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery - Secondary procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Secondary procedures performed on the same day as primary procedures and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for the procedure.'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery - Subsequent procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Any subsequent procedures performed on the same day as the primary procedure and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for those procedures.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery - Subsequent procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Any subsequent procedures performed on the same day as the primary procedure and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for those procedures.'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Vision Exams (Includes Refraction) CPT 92002, 92004, 92012, 92014', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$56.95 Conversion Factor'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Vision Exams (Includes Refraction) CPT 92002, 92004, 92012, 92014', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$56.95 Conversion Factor', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 56.95, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Refraction CPT 92015', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$56.95 Conversion Factor. ODS only allows refraction codes to be reimbursed when paired with a diagnosis code of 367.0 - 367.9 \"refractive error\"'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Refraction CPT 92015', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$56.95 Conversion Factor. ODS only allows refraction codes to be reimbursed when paired with a diagnosis code of 367.0 - 367.9 \"refractive error\"', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 56.95, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Single Vision Spectacle Lenses CPT V2100-V2114', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$52.00'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Single Vision Spectacle Lenses CPT V2100-V2114', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$52.00', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Unit', 'REIMB_FEE_RATE': 52.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Specialty Single Vision Lenses CPT V2115-V2199', 'CARVEOUT_IND': nan, 'REIMB_TERM': '10% Discount off Billed Charges'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Specialty Single Vision Lenses CPT V2115-V2199', 'CARVEOUT_IND': nan, 'REIMB_TERM': '10% Discount off Billed Charges', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '90', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Bifocal Spectacle Lenses CPT V2200-V2214', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$75.00'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Bifocal Spectacle Lenses CPT V2200-V2214', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$75.00', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 75.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Specialty Bifocal Vision Lenses CPT V2215-V2299', 'CARVEOUT_IND': nan, 'REIMB_TERM': '10% Discount off Billed Charges'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Specialty Bifocal Vision Lenses CPT V2215-V2299', 'CARVEOUT_IND': nan, 'REIMB_TERM': '10% Discount off Billed Charges', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '90', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Trifocal Spectacle Lenses CPT V2300-V2314', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$98.00'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Trifocal Spectacle Lenses CPT V2300-V2314', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$98.00', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 98.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Specialty Trifocal Vision Lenses CPT V2315-V2399', 'CARVEOUT_IND': nan, 'REIMB_TERM': '10% Discount off Billed Charges'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Specialty Trifocal Vision Lenses CPT V2315-V2399', 'CARVEOUT_IND': nan, 'REIMB_TERM': '10% Discount off Billed Charges', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '90', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Progressive Spectacle Lenses CPT V2781', 'CARVEOUT_IND': nan, 'REIMB_TERM': '20% Discount off Billed Charges. ODS will pay up to benefit maximum. Outstanding balance can be billed to member.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Progressive Spectacle Lenses CPT V2781', 'CARVEOUT_IND': nan, 'REIMB_TERM': '20% Discount off Billed Charges. ODS will pay up to benefit maximum. Outstanding balance can be billed to member.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '80', 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Frames V 2020-V2025', 'CARVEOUT_IND': nan, 'REIMB_TERM': '20% Discount off Billed Charges. ODS will pay up to benefit maximum. Outstanding balance can be billed to member.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Frames V 2020-V2025', 'CARVEOUT_IND': nan, 'REIMB_TERM': '20% Discount off Billed Charges. ODS will pay up to benefit maximum. Outstanding balance can be billed to member.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '80', 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Contact Lenses (Regular & Disposable) V2500-V2599', 'CARVEOUT_IND': nan, 'REIMB_TERM': '10% Discount off Billed Charges. ODS will pay up to benefit maximum. Outstanding balance can be billed to member.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Contact Lenses (Regular & Disposable) V2500-V2599', 'CARVEOUT_IND': nan, 'REIMB_TERM': '10% Discount off Billed Charges. ODS will pay up to benefit maximum. Outstanding balance can be billed to member.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '90', 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Contact Lens Fitting Fee 92310-92317', 'CARVEOUT_IND': nan, 'REIMB_TERM': '10% Discount off Billed Charges. ODS will pay up to benefit maximum. Outstanding balance can be billed to member.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Contact Lens Fitting Fee 92310-92317', 'CARVEOUT_IND': nan, 'REIMB_TERM': '10% Discount off Billed Charges. ODS will pay up to benefit maximum. Outstanding balance can be billed to member.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '90', 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted procedures or no RVU for Covered Services', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': '20% Discount off Billed Charges. ODS will pay up to benefit maximum. Outstanding balance can be billed to member.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted procedures or no RVU for Covered Services', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': '20% Discount off Billed Charges. ODS will pay up to benefit maximum. Outstanding balance can be billed to member.'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Materials and Lens Extras V2410-V2430 V2623-V2786', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"20% Discount off Billed Charges. Please reference member's employee handbook for covered benefit detail\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered Materials and Lens Extras V2410-V2430 V2623-V2786', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"20% Discount off Billed Charges. Please reference member's employee handbook for covered benefit detail\", 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '80', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Non-Covered Materials', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'No Discount off Billed Charges'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Non-Covered Materials', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'No Discount off Billed Charges', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Birth Center Services CPT 59899', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Reimbursed at billed charges to a maximum of $2,200.00 case rate. Maximum postpartum stay is 12 hours for mother and baby.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Birth Center Services CPT 59899', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Reimbursed at billed charges to a maximum of $2,200.00 case rate. Maximum postpartum stay is 12 hours for mother and baby.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 2200.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Birth Center Services CPT 59899', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Reimbursed at billed charges to a maximum of $2,200.00 case rate. Maximum postpartum stay is 12 hours for mother and baby.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Case Rate', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 2200.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'RN & LPN Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'RN & LPN Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'RN & LPN Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': '226.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'RN & LPN Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'RN & LPN Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'RN & LPN Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': '205.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Physical Therapy Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Physical Therapy Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Physical Therapy Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': '226.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Physical Therapy Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Physical Therapy Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Physical Therapy Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': '205.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Occupational Therapy Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Occupational Therapy Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Occupational Therapy Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': '226.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Occupational Therapy Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Occupational Therapy Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Occupational Therapy Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': '205.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Speech Therapy Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Speech Therapy Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Speech Therapy Admit Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $226.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': '226.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Speech Therapy Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Speech Therapy Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Speech Therapy Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': '205.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medical Social Worker Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $272.00 Per Visit\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medical Social Worker Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $272.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medical Social Worker Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $272.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': '272.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medical Social Work Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medical Social Work Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medical Social Work Subsequent Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $205.00 Per Visit\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': '205.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Health Aide Revenue Code 570, 571, 579', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or $116.00 Per Visit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Health Aide Revenue Code 570, 571, 579', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or $116.00 Per Visit', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Health Aide Revenue Code 570, 571, 579', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or $116.00 Per Visit', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': '116.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Health Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or the fee schedule maximum approved by ODS.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Health Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or the fee schedule maximum approved by ODS.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Health Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or the fee schedule maximum approved by ODS.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'fee schedule maximum approved by ODS', 'AARETE_DERIVED_FEE_SCHEDULE': 'Health Plan', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Routine Home Hospice Care T2042', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $195.00 Per Diem\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Routine Home Hospice Care T2042', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $195.00 Per Diem\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Routine Home Hospice Care T2042', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $195.00 Per Diem\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': 'Per Diem', 'REIMB_FEE_RATE': '195.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Continuous Home Hospice Care T2043', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $43.00 Per Hour (min 8 hrs, max 24 hrs)\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Continuous Home Hospice Care T2043', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $43.00 Per Hour (min 8 hrs, max 24 hrs)\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Continuous Home Hospice Care T2043', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $43.00 Per Hour (min 8 hrs, max 24 hrs)\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Hour', 'REIMB_FEE_RATE': '43.00', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Respite Care T2044', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $195.00 Per Diem\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Respite Care T2044', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $195.00 Per Diem\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Respite Care T2044', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $195.00 Per Diem\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': 'Per Diem', 'REIMB_FEE_RATE': '195.00', 'REIMB_PCT_RATE': '', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Hospice Care T2045 T2046', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $766.00 Per Diem\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Hospice Care T2045 T2046', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $766.00 Per Diem\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Hospice Care T2045 T2046', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's normal fee for such service or $766.00 Per Diem\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': 'Per Diem', 'REIMB_FEE_RATE': 766.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Allow at one hundred and six percent (106%) of the Medicare Average Sales Price (ASP) in effect as of January 1, 2013. ODS will not implement Medicare quarterly updates. In the event there is no Medicare ASP, reimbursement will be based on the Wholesale Acquisition Cost (WAC) available as of January 1, 2013 for injectable drugs billed using HCPCS, J-codes, and Q-codes.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Allow at one hundred and six percent (106%) of the Medicare Average Sales Price (ASP) in effect as of January 1, 2013. ODS will not implement Medicare quarterly updates. In the event there is no Medicare ASP, reimbursement will be based on the Wholesale Acquisition Cost (WAC) available as of January 1, 2013 for injectable drugs billed using HCPCS, J-codes, and Q-codes.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'ASP', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 106, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Allow at one hundred and six percent (106%) of the Medicare Average Sales Price (ASP) in effect as of January 1, 2013. ODS will not implement Medicare quarterly updates. In the event there is no Medicare ASP, reimbursement will be based on the Wholesale Acquisition Cost (WAC) available as of January 1, 2013 for injectable drugs billed using HCPCS, J-codes, and Q-codes.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'WAC', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'Y', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted Procedures and/or Supplies', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Unlisted procedures will be allowed at seventy percent (70%) of billed charges for medically necessary or unlisted procedures (a procedure without a Relative Value Unit).'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted Procedures and/or Supplies', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Unlisted procedures will be allowed at seventy percent (70%) of billed charges for medically necessary or unlisted procedures (a procedure without a Relative Value Unit).'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 24 hours S9500', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 24 hours S9500', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 24 hours S9500', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '125', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 12 hours S9501', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 12 hours S9501', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 12 hours S9501', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '125', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 8 hours S9502', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 8 hours S9502', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 8 hours S9502', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '125', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 6 hours S9503', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 6 hours S9503', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 6 hours S9503', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '125', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 4 hours S9504', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 4 hours S9504', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 4 hours S9504', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '125', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 3 hours S9497', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 3 hours S9497', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Antibiotic Therapy, every 3 hours S9497', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Per Diem, Drug Rate (CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '125', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home IV Core Therapy Per Diems Catheter Insertion, Maintenance and Care - Home Infusion therapy, catheter care/maintenance, not otherwise classified; includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home IV Core Therapy Per Diems Catheter Insertion, Maintenance and Care - Home Infusion therapy, catheter care/maintenance, not otherwise classified; includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home IV Core Therapy Per Diems Catheter Insertion, Maintenance and Care - Home Infusion therapy, catheter care/maintenance, simple (single lumen), includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home IV Core Therapy Per Diems Catheter Insertion, Maintenance and Care - Home Infusion therapy, catheter care/maintenance, simple (single lumen), includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion therapy, catheter care/maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately) S5501', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion therapy, catheter care/maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately) S5501', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion therapy, catheter care/maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), (use this code for interim maintenance of vascular access not currently in use) S5502', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion therapy, catheter care/maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), (use this code for interim maintenance of vascular access not currently in use) S5502', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting S5517', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting S5517', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies necessary for catheter repair S5518', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies necessary for catheter repair S5518', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies (including catheter) necessary for peripherally inserted central venous catheter (PICC) line insertion S5520', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies (including catheter) necessary for peripherally inserted central venous catheter (PICC) line insertion S5520', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies (including catheter) necessary for midline catheter insertion S5521', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies (including catheter) necessary for midline catheter insertion S5521', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, hydration therapy; 1 liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, hydration therapy; 1 liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, hydration therapy; more than 1 liter but no more than 2 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visit coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, hydration therapy; more than 1 liter but no more than 2 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visit coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion - Electrolytes', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The per diem includes any combination of electrolytes to be administered intravenously.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion - Electrolytes', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The per diem includes any combination of electrolytes to be administered intravenously.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion - Additional medications', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Additional medications will be charged separately at CMS+15%.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion - Additional medications', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Additional medications will be charged separately at CMS+15%.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, hydration therapy; more 2 liters but no more than 3 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, hydration therapy; more 2 liters but no more than 3 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, hydration therapy; more than 3 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visit coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, hydration therapy; more than 3 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visit coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Additional medications', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Additional medications', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, alpha-1 proteinase inhibitor (e.g., Prolastin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, alpha-1 proteinase inhibitor (e.g., Prolastin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, continuous anticoagulant infusion therapy e.g.Heparin), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, continuous anticoagulant infusion therapy e.g.Heparin), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home therapy; intermittent anticogulant injection therapy (e.g., Heparin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home therapy; intermittent anticogulant injection therapy (e.g., Heparin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, continuous or intermittent antiemetic infusion therapy; administrative services professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, continuous or intermittent antiemetic infusion therapy; administrative services professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'CMS+15%', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home therapy, intermittent antiemetic injection therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visit coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home therapy, intermittent antiemetic injection therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visit coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, antitumor necrosis factor intravenous therapy; (e.g. Infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, antitumor necrosis factor intravenous therapy; (e.g. Infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, continuous (24 hours or more) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, continuous (24 hours or more) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, intermittent (less than 24 hours) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, intermittent (less than 24 hours) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, enzyme replacement intravenous therapy, (e.g. Imiglucerase); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, enzyme replacement intravenous therapy, (e.g. Imiglucerase); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+25%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+25%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 125, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, antispasmotic therapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, antispasmotic therapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e.g. Dobutamine); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e.g. Dobutamine); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion Therapy, Corticosteroid Infusion Therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion Therapy, Corticosteroid Infusion Therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion Therapy, Level II Immunosuppressive Infusion Therapy (e.g. Cyclosporine, Prograf, CellCept, Thymoglobulin, Atgam); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion Therapy, Level II Immunosuppressive Infusion Therapy (e.g. Cyclosporine, Prograf, CellCept, Thymoglobulin, Atgam); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion Therapy, Level III Immunosuppressive Infusion Therapy (e.g. Zenapax); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Infusion Therapy, Level III Immunosuppressive Infusion Therapy (e.g. Zenapax); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Interferon administered intravenously', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Shall be coded and billed with S9379, the infusion therapy, not otherwise classified rate.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Interferon administered intravenously', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Shall be coded and billed with S9379, the infusion therapy, not otherwise classified rate.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Interferon Therapy - Home Injectable Therapy, Interferon; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Interferon Therapy - Home Injectable Therapy, Interferon; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'S9537 - Hematopoietic hormone injection therapy', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'S9537 applies only to hematopoietic hormone injection therapy only.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'S9537 - Hematopoietic hormone injection therapy', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'S9537 applies only to hematopoietic hormone injection therapy only.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'S9379 - Hematopoietic hormone therapy administered intravenously', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'S9379 (infusion therapy, not otherwise classified) and the rate shall be equal to the rate for S9379'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'S9379 - Hematopoietic hormone therapy administered intravenously', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'S9379 (infusion therapy, not otherwise classified) and the rate shall be equal to the rate for S9379', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Growth Hormone Therapy - Home Injectable Therapy, growth hormone; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Growth Hormone Therapy - Home Injectable Therapy, growth hormone; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'S9537 hematopoietic hormone injection therapy', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'S9537 applies only to hematopoietic hormone injection therapy only.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'S9537 hematopoietic hormone injection therapy', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'S9537 applies only to hematopoietic hormone injection therapy only.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'S9379 hematopoietic hormone therapy administered intravenously', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Hematopoietic hormone therapy administered intravenously shall be coded with S9379 (infusion therapy, not otherwise classified) and the rate shall be equal to the rate for S9379'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'S9379 hematopoietic hormone therapy administered intravenously', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Hematopoietic hormone therapy administered intravenously shall be coded with S9379 (infusion therapy, not otherwise classified) and the rate shall be equal to the rate for S9379', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Transfusion of blood product(s), administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (blood products, drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Transfusion of blood product(s), administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (blood products, drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hematopoietic Hormone Therapy (e.g. EPOGEN, NEUPOGEN) S9537', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Home Therapy; Hematopoietic Hormone Injection Therapy (e.g. erythropoietin, G-CSF, GM-CSF); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hematopoietic Hormone Therapy (e.g. EPOGEN, NEUPOGEN) S9537', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Home Therapy; Hematopoietic Hormone Injection Therapy (e.g. erythropoietin, G-CSF, GM-CSF); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hematopoietic hormone therapy administered intravenously S9379', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Infusion therapy, not otherwise classified; rate shall be equal to the rate for S9379'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hematopoietic hormone therapy administered intravenously S9379', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Infusion therapy, not otherwise classified; rate shall be equal to the rate for S9379', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hematopoietic hormone injection therapy S9537', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'S9537 applies only to hematopoietic hormone injection therapy only.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hematopoietic hormone injection therapy S9537', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'S9537 applies only to hematopoietic hormone injection therapy only.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hematopoietic hormone therapy administered intravenously S9379', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Hematopoietic hormone therapy administered intravenously shall be coded with S9379 (infusion therapy, not otherwise classified) and the rate shall be equal to the rate for S9379'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hematopoietic hormone therapy administered intravenously S9379', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Hematopoietic hormone therapy administered intravenously shall be coded with S9379 (infusion therapy, not otherwise classified) and the rate shall be equal to the rate for S9379', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hormonal Therapy (e.g. LEUPROLIDE, GOSERELIN) S9560', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Home injectable therapy; hormonal therapy (e.g. leuprolide, goserelin), administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hormonal Therapy (e.g. LEUPROLIDE, GOSERELIN) S9560', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Home injectable therapy; hormonal therapy (e.g. leuprolide, goserelin), administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Diuretic Therapy - Home infusion therapy, diuretic intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Diuretic Therapy - Home infusion therapy, diuretic intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Aerosolized Drug Therapy (e.g. PENTAMIDINE)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Home administration of aerosolized drug therapy (e.g. Pentamidine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Aerosolized Drug Therapy (e.g. PENTAMIDINE)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Home administration of aerosolized drug therapy (e.g. Pentamidine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem (CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Abatacept Therapy (e.g. ORENCIA) Home infusion therapy, ABATACEPT; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Abatacept Therapy (e.g. ORENCIA) Home infusion therapy, ABATACEPT; administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), Per Diem', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, implanted pump pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, implanted pump pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion/specialty drug administration, up to 2 hours (99601)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$205.00 Per Visit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion/specialty drug administration, up to 2 hours (99601)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$205.00 Per Visit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': 205.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion/specialty drug administration, up to 2 hours. With specialized, highly technical home infusion training. (99601- SD)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$205.00 Per Visit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion/specialty drug administration, up to 2 hours. With specialized, highly technical home infusion training. (99601- SD)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$205.00 Per Visit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': 205.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion/specialty drug administration, up to 2 hours, each additional hour (99602)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$68.00 each additional hour'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion/specialty drug administration, up to 2 hours, each additional hour (99602)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$68.00 each additional hour', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Hour', 'REIMB_FEE_RATE': 68.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion/specialty drug administration, up to 2 hours (99601-SS)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$180.00 Per Visit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion/specialty drug administration, up to 2 hours (99601-SS)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$180.00 Per Visit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': 180.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion/specialty drug administration, up to 2 hours, each additional hour (99602-SS)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$44.00 each additional hour'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion/specialty drug administration, up to 2 hours, each additional hour (99602-SS)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$44.00 each additional hour', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Hour', 'REIMB_FEE_RATE': 44.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies (including catheter) necessary for peripherally inserted central venous catheter (PICC) line insertion (S5520)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$105.00 Per Kit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies (including catheter) necessary for peripherally inserted central venous catheter (PICC) line insertion (S5520)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$105.00 Per Kit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Kit', 'REIMB_FEE_RATE': 105.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies (including catheter) necessary for midline catheter insertion (S5521)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$105.00 Per Kit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, all supplies (including catheter) necessary for midline catheter insertion (S5521)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$105.00 Per Kit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Kit', 'REIMB_FEE_RATE': 105.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, insertion of peripherally inserted central venous catheter (PICC), nursing services only (no supplies or catheter included) (S5522)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$175.00 Per Procedure'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, insertion of peripherally inserted central venous catheter (PICC), nursing services only (no supplies or catheter included) (S5522)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$175.00 Per Procedure', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Procedure', 'REIMB_FEE_RATE': 175.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, insertion of midline venous catheter, nursing services only (no supplies or catheter included) (S5523)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$115.00 Per Procedure'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, insertion of midline venous catheter, nursing services only (no supplies or catheter included) (S5523)', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$115.00 Per Procedure', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Procedure', 'REIMB_FEE_RATE': 115.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, total parenteral nutrition (TPN); 1 liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, total parenteral nutrition (TPN); 1 liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, total parenteral nutrition (TPN); more than 1 liter but no more than 2 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, total parenteral nutrition (TPN); more than 1 liter but no more than 2 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, total parenteral nutrition (TPN); more than 2 liters but no more than 3 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, total parenteral nutrition (TPN); more than 2 liters but no more than 3 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, total parenteral nutrition (TPN), more than 3 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home infusion therapy, total parenteral nutrition (TPN), more than 3 liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(CMS+15%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '115', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'CMS', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Parenteral nutrition solution, per 10 grams lipids', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(Retail -30%)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Parenteral nutrition solution, per 10 grams lipids', 'CARVEOUT_IND': nan, 'REIMB_TERM': '(Retail -30%)', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '70', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Parenteral nutrition solution: compounded aminoacid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal - Amirosyn RF, NephrAmine, RenAmine - premix', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The per diem rate for standard TPN solution includes: non-specialty amino acids, concentrated dextrose, sterile water, electrolytes, standard multi-trace element solutions and standard multivitamin solutions.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Parenteral nutrition solution: compounded aminoacid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal - Amirosyn RF, NephrAmine, RenAmine - premix', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The per diem rate for standard TPN solution includes: non-specialty amino acids, concentrated dextrose, sterile water, electrolytes, standard multi-trace element solutions and standard multivitamin solutions.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Parenteral nutrition solution: compounded aminoacid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, stress - branch chain amino acids - premix', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The per diem rate for standard TPN solution includes: non-specialty amino acids, concentrated dextrose, sterile water, electrolytes, standard multi-trace element solutions and standard multivitamin solutions.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Parenteral nutrition solution: compounded aminoacid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, stress - branch chain amino acids - premix', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The per diem rate for standard TPN solution includes: non-specialty amino acids, concentrated dextrose, sterile water, electrolytes, standard multi-trace element solutions and standard multivitamin solutions.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Parenteral and Enteral Nutrition Items & Services (PEN)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'ODS shall compensate Provider one hundred (100%) percent of the 2012 Medicare Parenteral and Enteral Nutrition (PEN) Medicare Fee Schedule.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Parenteral and Enteral Nutrition Items & Services (PEN)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'ODS shall compensate Provider one hundred (100%) percent of the 2012 Medicare Parenteral and Enteral Nutrition (PEN) Medicare Fee Schedule.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '2012 Medicare Parenteral and Enteral Nutrition (PEN) Medicare Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'Medicare', 'FEE_SCHEDULE_VERSION': '2012', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': '2012'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit HCPCS CODE B4160', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$ 2.60 per unit, 100 calories = I unit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit HCPCS CODE B4160', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$ 2.60 per unit, 100 calories = I unit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Unit', 'REIMB_FEE_RATE': 2.6, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit HCPCS CODE B4161', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$ 6.80 per unit, 100 calories = 1 unit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit HCPCS CODE B4161', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$ 6.80 per unit, 100 calories = 1 unit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Unit', 'REIMB_FEE_RATE': 6.8, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit HCPCS CODE B4162', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$ 5.20 per unit, 100 calories = I unit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit HCPCS CODE B4162', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$ 5.20 per unit, 100 calories = I unit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Unit', 'REIMB_FEE_RATE': 5.2, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or ninety (90%) percent of billed charges for all covered inpatient services'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or ninety (90%) percent of billed charges for all covered inpatient services', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '90', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or ninety (90%) percent of billed charges for all covered inpatient services', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or ninety (90%) percent of billed charges for all covered outpatient services'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or ninety (90%) percent of billed charges for all covered outpatient services', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '90', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or ninety (90%) percent of billed charges for all covered outpatient services', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery Secondary procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'The lesser of its normal fee for such service or 50% of the allowed amount for the procedure when performed on the same day as primary procedures and are Status Indicator T procedures as defined by Medicare OPPS Addendum B'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery Secondary procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'The lesser of its normal fee for such service or 50% of the allowed amount for the procedure when performed on the same day as primary procedures and are Status Indicator T procedures as defined by Medicare OPPS Addendum B'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Subsequent procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'The lesser of its normal fee for such service or 50% of the allowed amount for those procedures when performed on the same day as the primary procedure and are Status Indicator T procedures as defined by Medicare OPPS Addendum B'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Subsequent procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'The lesser of its normal fee for such service or 50% of the allowed amount for those procedures when performed on the same day as the primary procedure and are Status Indicator T procedures as defined by Medicare OPPS Addendum B'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Pre-admission tests', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Pre-admission tests within 3 days of an admission should be included with the admission and not billed separately consistent with Medicare rules'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Pre-admission tests', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Pre-admission tests within 3 days of an admission should be included with the admission and not billed separately consistent with Medicare rules', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Grouper', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Prosthetics and Implants', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'For covered services paid at a percent of charge, prosthetics and implants will be paid at rates set forth herein and not limited to invoice cost'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Prosthetics and Implants', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'For covered services paid at a percent of charge, prosthetics and implants will be paid at rates set forth herein and not limited to invoice cost', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Laboratory services without an RBRVS weight', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Allowed at 130% of the 2013 Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Laboratory services without an RBRVS weight', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Allowed at 130% of the 2013 Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Laboratory services without an RBRVS weight', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Allowed at 130% of the 2013 Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '130', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '2013 Medicare Clinical Diagnostic Lab Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'Medicare', 'FEE_SCHEDULE_VERSION': '2013', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': '2013'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $61.00.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $52.50. Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $52.50. Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $52.50. Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '52.50', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $52.50. Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\", 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RVU', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered services performed by Mid-Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed at eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered services performed by Mid-Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed at eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered services performed by Mid-Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed at eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '85', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Maximum Fees', 'AARETE_DERIVED_FEE_SCHEDULE': 'Proprietary', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered services performed by Mid-Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed at eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '85', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hearing Aid Services - Fitting, Orientation and Checking of Hearing Aids', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Reimbursed using the Medicine Conversion Factor (see Fee Schedule under this Exhibit) and are subject to any Hearing Aid benefit limitation.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hearing Aid Services - Fitting, Orientation and Checking of Hearing Aids', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Reimbursed using the Medicine Conversion Factor (see Fee Schedule under this Exhibit) and are subject to any Hearing Aid benefit limitation.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Medicine Conversion Factor', 'AARETE_DERIVED_FEE_SCHEDULE': 'Health Plan', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted Procedures and/or Supplies (not including Hearing Aids)', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Eighty percent (80%) of billed charges for medically necessary supplies or unlisted procedures (a procedure without a Relative Value Unit).'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted Procedures and/or Supplies (not including Hearing Aids)', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Eighty percent (80%) of billed charges for medically necessary supplies or unlisted procedures (a procedure without a Relative Value Unit).'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred thirty percent (130%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred thirty percent (130%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'ASP', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 130, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred thirty percent (130%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'WAC', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. If there is no fee schedule for DME, ODS requires that the purchase price for any DME be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to a maximum of twelve (12) consecutive months. ODS will not implement Medicare quarterly updates.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. If there is no fee schedule for DME, ODS requires that the purchase price for any DME be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to a maximum of twelve (12) consecutive months. ODS will not implement Medicare quarterly updates.', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 105, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '2013 Medicare DMEPOS schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'Medicare', 'FEE_SCHEDULE_VERSION': '2013', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': '2013'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. If there is no fee schedule for DME, ODS requires that the purchase price for any DME be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to a maximum of twelve (12) consecutive months. ODS will not implement Medicare quarterly updates.', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. If there is no fee schedule for DME, ODS requires that the purchase price for any DME be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to a maximum of twelve (12) consecutive months. ODS will not implement Medicare quarterly updates.', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Reimbursement below Cost', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'If reimbursement is below acquisition cost, Provider can submit an appeal and the claim will be paid at cost when an invoice is included with the claim.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Reimbursement below Cost', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'If reimbursement is below acquisition cost, Provider can submit an appeal and the claim will be paid at cost when an invoice is included with the claim.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Cost Plus', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or Ninety (95%) percent of billed charges for all covered inpatient services'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or Ninety (95%) percent of billed charges for all covered inpatient services', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '95', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or Ninety (95%) percent of billed charges for all covered inpatient services', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or Ninety (95%) percent of billed charges for all covered outpatient services'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or Ninety (95%) percent of billed charges for all covered outpatient services', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '95', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'The lesser of its normal fee for such service or Ninety (95%) percent of billed charges for all covered outpatient services', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery Secondary procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Secondary procedures performed on the same day as primary procedures and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for the procedure. Any subsequent procedures performed on the same day as the primary procedure and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for those procedures.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery Secondary procedures', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Secondary procedures performed on the same day as primary procedures and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for the procedure. Any subsequent procedures performed on the same day as the primary procedure and are Status Indicator T procedures as defined by Medicare OPPS Addendum B will be reimbursed at 50% of the allowed amount for those procedures.'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $11,650 Conversion Factor multiplied by the 10-1-12 MS-DRG table weight (version 30) or 100% of Hospitals' billed charges. The 10-1-12 MS-DRG table weights will be used for the contract term 8-1-13 to 6-30-14. If MS-DRG from the 10-1-12 MS-DRG table splits into new MS-DRGs on 10-1-13 (version 31), the weight from the 10-1-12 MS-DRG table will be applied to the new MS-DRGs.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $11,650 Conversion Factor multiplied by the 10-1-12 MS-DRG table weight (version 30) or 100% of Hospitals' billed charges. The 10-1-12 MS-DRG table weights will be used for the contract term 8-1-13 to 6-30-14. If MS-DRG from the 10-1-12 MS-DRG table splits into new MS-DRGs on 10-1-13 (version 31), the weight from the 10-1-12 MS-DRG table will be applied to the new MS-DRGs.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Grouper', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 11650, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $11,650 Conversion Factor multiplied by the 10-1-12 MS-DRG table weight (version 30) or 100% of Hospitals' billed charges. The 10-1-12 MS-DRG table weights will be used for the contract term 8-1-13 to 6-30-14. If MS-DRG from the 10-1-12 MS-DRG table splits into new MS-DRGs on 10-1-13 (version 31), the weight from the 10-1-12 MS-DRG table will be applied to the new MS-DRGs.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': None, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Rehab DRG 945-946', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $1,844.00 Per Diem or 100% of Hospitals' billed charges\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Rehab DRG 945-946', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $1,844.00 Per Diem or 100% of Hospitals' billed charges\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': 'Per Day', 'REIMB_FEE_RATE': 1844.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Rehab DRG 945-946', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of $1,844.00 Per Diem or 100% of Hospitals' billed charges\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': None, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Stop Loss Provision', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'Threshold: 270% of Case Rate, as applicable. Percent Allowed Above Threshold: 70%. When inpatient charges exceed the Threshold, seventy percent (70%) of the amount in excess of the Threshold is allowed in addition to the applicable Case Rate.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Stop Loss Provision', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'Threshold: 270% of Case Rate, as applicable. Percent Allowed Above Threshold: 70%. When inpatient charges exceed the Threshold, seventy percent (70%) of the amount in excess of the Threshold is allowed in addition to the applicable Case Rate.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Case Rate', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '270', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Stop Loss Provision', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'Threshold: 270% of Case Rate, as applicable. Percent Allowed Above Threshold: 70%. When inpatient charges exceed the Threshold, seventy percent (70%) of the amount in excess of the Threshold is allowed in addition to the applicable Case Rate.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Outlier', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '70', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Prosthetics and Implants', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"If eligible for separate reimbursement under CMS guidelines, Prosthetics and Implants will be paid at one hundred (100%) percent of billed charges, not to exceed acquisition cost plus ten (10%) percent. Audits will be done to establish conformity and substantiate billed charges for these items. For audits, as well as on request, Provider is required to provide the manufacturer's invoice. Invoices must be dated within six months of the date of service and be for the specific device implanted in each case. Refunds may be requested for amounts paid that are not consistent with this pricing methodology. In accordance with CMS guidelines, ODS will not separately reimburse implants on procedure codes that are classified as device intensive.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Prosthetics and Implants', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"If eligible for separate reimbursement under CMS guidelines, Prosthetics and Implants will be paid at one hundred (100%) percent of billed charges, not to exceed acquisition cost plus ten (10%) percent. Audits will be done to establish conformity and substantiate billed charges for these items. For audits, as well as on request, Provider is required to provide the manufacturer's invoice. Invoices must be dated within six months of the date of service and be for the specific device implanted in each case. Refunds may be requested for amounts paid that are not consistent with this pricing methodology. In accordance with CMS guidelines, ODS will not separately reimburse implants on procedure codes that are classified as device intensive.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Prosthetics and Implants', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"If eligible for separate reimbursement under CMS guidelines, Prosthetics and Implants will be paid at one hundred (100%) percent of billed charges, not to exceed acquisition cost plus ten (10%) percent. Audits will be done to establish conformity and substantiate billed charges for these items. For audits, as well as on request, Provider is required to provide the manufacturer's invoice. Invoices must be dated within six months of the date of service and be for the specific device implanted in each case. Refunds may be requested for amounts paid that are not consistent with this pricing methodology. In accordance with CMS guidelines, ODS will not separately reimburse implants on procedure codes that are classified as device intensive.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Cost Plus', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 10, 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of 68% of Billed Charges or 100% of Hospitals' billed charges\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of 68% of Billed Charges or 100% of Hospitals' billed charges\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 68, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Outpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of 68% of Billed Charges or 100% of Hospitals' billed charges\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of (Conversion Factor multiplied by the 10-1-12 MS-DRG table weight (version 30)) or 100% of Hospitals' billed charges. The 10-1-12 MS-DRG table weights will be used for the contract term 8-1-13 to 6-30-14. If MS-DRG from the 10-1-12 MS-DRG table splits into new MS-DRGs on 10-1-13 (version 31), the weight from the 10-1-12 MS-DRG table will be applied to the new MS-DRGs.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of (Conversion Factor multiplied by the 10-1-12 MS-DRG table weight (version 30)) or 100% of Hospitals' billed charges. The 10-1-12 MS-DRG table weights will be used for the contract term 8-1-13 to 6-30-14. If MS-DRG from the 10-1-12 MS-DRG table splits into new MS-DRGs on 10-1-13 (version 31), the weight from the 10-1-12 MS-DRG table will be applied to the new MS-DRGs.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Grouper', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Services', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of (Conversion Factor multiplied by the 10-1-12 MS-DRG table weight (version 30)) or 100% of Hospitals' billed charges. The 10-1-12 MS-DRG table weights will be used for the contract term 8-1-13 to 6-30-14. If MS-DRG from the 10-1-12 MS-DRG table splits into new MS-DRGs on 10-1-13 (version 31), the weight from the 10-1-12 MS-DRG table will be applied to the new MS-DRGs.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $71.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied)\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $71.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied)\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $71.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied)\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '71.00', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $71.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied)\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $71.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied)\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $71.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied)\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '71.00', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $47.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied). Laboratory services without an RBRVS weight will be allowed at 120% of the 2013 Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $47.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied). Laboratory services without an RBRVS weight will be allowed at 120% of the 2013 Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $47.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied). Laboratory services without an RBRVS weight will be allowed at 120% of the 2013 Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': 47.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $47.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied). Laboratory services without an RBRVS weight will be allowed at 120% of the 2013 Medicare Clinical Diagnostic Lab Fee Schedule available as of January 1.\", 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 120, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '2013 Medicare Clinical Diagnostic Lab Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'Medicare', 'FEE_SCHEDULE_VERSION': '2013', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': '2013'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $71.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied)\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $71.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied)\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $71.00 conversion factor based upon the 2011 RBRVS version as printed in the Federal Register January 1 using the Fully Implemented, Site of Service Based RVU (No GPCI or BNA applied)\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '71.00', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $57.00 conversion factor. Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $57.00 conversion factor. Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or $57.00 conversion factor. Anesthesia will be reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '57.00', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered services performed by Mid Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered services performed by Mid Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 85, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': \"Mid Level Professionals that request credentialing, as a Primary Care Provider and meet Health Plan's requirements for PCP status\", 'CARVEOUT_IND': nan, 'REIMB_TERM': 'reimbursed at the Maximum Fees'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': \"Mid Level Professionals that request credentialing, as a Primary Care Provider and meet Health Plan's requirements for PCP status\", 'CARVEOUT_IND': nan, 'REIMB_TERM': 'reimbursed at the Maximum Fees', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'Y', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Fee Schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'FEE_SCHEDULE_VERSION': '', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'unspecified'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hearing Aid Services - Fitting, Orientation and Checking of Hearing Aids', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'reimbursed using the Medicine Conversion Factor (see Fee Schedule under this Exhibit) and are subject to any Hearing Aid benefit limitation'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Hearing Aid Services - Fitting, Orientation and Checking of Hearing Aids', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'reimbursed using the Medicine Conversion Factor (see Fee Schedule under this Exhibit) and are subject to any Hearing Aid benefit limitation', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Medicine Conversion Factor', 'AARETE_DERIVED_FEE_SCHEDULE': 'Health Plan', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted Procedures and/or Supplies (not including Hearing Aids)', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'allowed at seventy percent (70%) of billed charges for medically necessary supplies or unlisted procedures (a procedure without a Relative Value Unit)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted Procedures and/or Supplies (not including Hearing Aids)', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'allowed at seventy percent (70%) of billed charges for medically necessary supplies or unlisted procedures (a procedure without a Relative Value Unit)'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'one hundred fifteen percent (115%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'one hundred fifteen percent (115%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'ASP', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 115, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'one hundred fifteen percent (115%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'WAC', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'Y', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'one hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. ODS will not implement Medicare quarterly updates. For rental DME, ODS requires that the purchase price be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period of DME as defined by CMS.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'one hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. ODS will not implement Medicare quarterly updates. For rental DME, ODS requires that the purchase price be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period of DME as defined by CMS.', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 105, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '2013 Medicare DMEPOS schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'Medicare', 'FEE_SCHEDULE_VERSION': '2013', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': '2013'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Durable Medical Equipment (DME) (not including Hearing Aids)', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'one hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. ODS will not implement Medicare quarterly updates. For rental DME, ODS requires that the purchase price be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period of DME as defined by CMS.', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Second and Subsequent Surgeries', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'For inpatient and outpatient services, all subsequent procedures performed on the same day as primary procedures will be reimbursed at 50% of the allowed amount for the procedure.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Second and Subsequent Surgeries', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'For inpatient and outpatient services, all subsequent procedures performed on the same day as primary procedures will be reimbursed at 50% of the allowed amount for the procedure.'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'RN & LPN Subsequent Visit Revenue Code 551', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$191.00 Per Visit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'RN & LPN Subsequent Visit Revenue Code 551', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$191.00 Per Visit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': 191.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Health Aide Revenue Code 571', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$117.00 Per Visit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Home Health Aide Revenue Code 571', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$117.00 Per Visit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': 117.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Physical Therapy Subsequent Visit Revenue Code 421', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$191.00 Per Visit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Physical Therapy Subsequent Visit Revenue Code 421', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$191.00 Per Visit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': 191.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Occupational Therapy Subsequent Visit Revenue Code 431', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$191.00 Per Visit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Occupational Therapy Subsequent Visit Revenue Code 431', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$191.00 Per Visit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': 191.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Speech Therapy Subsequent Visit Revenue Code 441', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$191.00 Per Visit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Speech Therapy Subsequent Visit Revenue Code 441', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$191.00 Per Visit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': 191.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medical Social Worker Visit Revenue Code 561', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$191.00 Per Visit'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medical Social Worker Visit Revenue Code 561', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$191.00 Per Visit', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Visit', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': 191.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted Procedures and/or Supplies', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'seventy percent (70%) of billed charges for medically necessary or unlisted procedures (a procedure without a Relative Value Unit)'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Unlisted Procedures and/or Supplies', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'seventy percent (70%) of billed charges for medically necessary or unlisted procedures (a procedure without a Relative Value Unit)'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Routine Home Hospice Care T2042 Revenue Code 651', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$177.00 Per Diem'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Routine Home Hospice Care T2042 Revenue Code 651', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$177.00 Per Diem', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': 'Per Day', 'REIMB_FEE_RATE': 177.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Respite Care T2044 Revenue Code 655', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$254.00 Per Diem'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Respite Care T2044 Revenue Code 655', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$254.00 Per Diem', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': 'Per Day', 'REIMB_FEE_RATE': 254.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Hospice Care T2045, T2046 Revenue Code 656', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$888.00 Per Diem'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Inpatient Hospice Care T2045, T2046 Revenue Code 656', 'CARVEOUT_IND': nan, 'REIMB_TERM': '$888.00 Per Diem', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Per Diem', 'UNIT_OF_MEASURE': 'Per Day', 'REIMB_FEE_RATE': 888.0, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicine', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Surgery', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Lab/Pathology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Radiology', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursement will be based upon the 2013 RBRVS version as printed in the Federal Register January 1 using the Site of Service Based RVU (No GPCI or BNA applied) with a conversion factor of $74.00\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals. Conversion factor of $52.50\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals. Conversion factor of $52.50\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals. Conversion factor of $52.50\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'ASA', 'AARETE_DERIVED_FEE_SCHEDULE': 'Proprietary', 'FEE_SCHEDULE_VERSION': 'Most current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'most current'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Anesthesia', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed on Anesthesia Relative Value Units. Most current ASA methodology for standard AMA defined codes in the range 00100 through 01999. ASA time units will be based on 15 minute time intervals. Conversion factor of $52.50\", 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RVU', 'UNIT_OF_MEASURE': 'Per 15 minute', 'REIMB_FEE_RATE': '52.50', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered services performed by Mid Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed at eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered services performed by Mid Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed at eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '100', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered services performed by Mid Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed at eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '85', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Maximum Fees', 'AARETE_DERIVED_FEE_SCHEDULE': 'Proprietary', 'FEE_SCHEDULE_VERSION': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Covered services performed by Mid Level Professionals', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"The lesser of Provider's Billed Charges or the fee schedule maximum approved by ODS. Reimbursed at eighty five percent (85%) of the Maximum Fees. This applies to allowed amounts that are calculated using an RVU/Conversion Factor methodology.\", 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'RBRVS', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': '85', 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"Fee Schedule breakout\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'DME', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. ODS will not implement Medicare quarterly updates. For rental DME, ODS requires that the purchase price be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period of DME as defined by CMS.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'DME', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. ODS will not implement Medicare quarterly updates. For rental DME, ODS requires that the purchase price be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period of DME as defined by CMS.', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 105, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': '2013 Medicare DMEPOS schedule', 'AARETE_DERIVED_FEE_SCHEDULE': 'Medicare', 'FEE_SCHEDULE_VERSION': '2013', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': '2013'}, {'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'DME', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'One hundred five percent (105%) of the 2013 Medicare DMEPOS schedule, available as of January 1. ODS will not implement Medicare quarterly updates. For rental DME, ODS requires that the purchase price be supplied at the time of initial rental. ODS will pay the lesser of the amount required to purchase the DME or rental charges for DME, up to the maximum rental period of DME as defined by CMS.', 'LESSER_OF_IND': 'Y', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Billed Charges', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Second and Subsequent Surgeries - Outpatient services', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Subsequent (secondary or tertiary) procedures performed on the same day as primary procedures will be reimbursed at 50% of the allowed amount for the procedure.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Second and Subsequent Surgeries - Outpatient services', 'CARVEOUT_IND': 'Y', 'REIMB_TERM': 'Subsequent (secondary or tertiary) procedures performed on the same day as primary procedures will be reimbursed at 50% of the allowed amount for the procedure.'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'PCPCH Members', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"Provider shall receive a payment of $15 per Member per month for each Member enrolled with Provider. Such payments shall be calculated as of the Member's enrollment on the first day of the month, with payments remitted to Provider at the end of each calendar month.\"}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'PCPCH Members', 'CARVEOUT_IND': nan, 'REIMB_TERM': \"Provider shall receive a payment of $15 per Member per month for each Member enrolled with Provider. Such payments shall be calculated as of the Member's enrollment on the first day of the month, with payments remitted to Provider at the end of each calendar month.\", 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Month', 'REIMB_FEE_RATE': 15, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Wellness Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Provider shall receive a payment of $150 for each Wellness Visit, as defined below, subject to the limitations set forth herein. A Wellness Visit applies to Members who are age 21 and older, and shall include a comprehensive medical evaluation including an age and gender appropriate history, family medical history, examination, counseling, anticipatory guidance, and risk factor reduction intervention. The Wellness Visit shall be billed using HCPCS code G0439.'}\n",
|
||||
"[{'CONTRACT_FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Wellness Visit', 'CARVEOUT_IND': nan, 'REIMB_TERM': 'Provider shall receive a payment of $150 for each Wellness Visit, as defined below, subject to the limitations set forth herein. A Wellness Visit applies to Members who are age 21 and older, and shall include a comprehensive medical evaluation including an age and gender appropriate history, family medical history, examination, counseling, anticipatory guidance, and risk factor reduction intervention. The Wellness Visit shall be billed using HCPCS code G0439.', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Flat Rate', 'UNIT_OF_MEASURE': 'Per Visit', 'REIMB_FEE_RATE': 150, 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n"
|
||||
"{'FILE_NAME': '2018 09 01 UTMB (Amendment 10 change in reimbursement) MU.txt', 'SERVICE_TERM': 'Stop Loss', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'When Billed Charge is equal to or greater than the catastrophic threshold of three hundred thousand dollars ($300,000) for a particular confinement, then the entire reimbursement will be paid at forty-seven percent (47%) of Billed Charges (first dollar stop loss).'}\n",
|
||||
"[{'FILE_NAME': '2018 09 01 UTMB (Amendment 10 change in reimbursement) MU.txt', 'SERVICE_TERM': 'Stop Loss', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'When Billed Charge is equal to or greater than the catastrophic threshold of three hundred thousand dollars ($300,000) for a particular confinement, then the entire reimbursement will be paid at forty-seven percent (47%) of Billed Charges (first dollar stop loss).', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Percent of Charge', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 47, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE': 'N/A', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'N/A'}]\n",
|
||||
"{'FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof MU.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'One hundred thirty percent (130%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).'}\n",
|
||||
"[{'FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof MU.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'One hundred thirty percent (130%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 130, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Medicare Average Sales Price (ASP) for Medicare Part B Drugs', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS Part B Drug', 'FEE_SCHEDULE_VERSION': 'then-current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}, {'FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof MU.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'One hundred thirty percent (130%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'Y', 'FEE_SCHEDULE': 'Medicare Average Sales Price (ASP) for Medicare Part B Drugs', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS Part B Drug', 'FEE_SCHEDULE_VERSION': 'then-current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n",
|
||||
"{'FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'One hundred thirty percent (130%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).'}\n",
|
||||
"[{'FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'One hundred thirty percent (130%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 130, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'N', 'FEE_SCHEDULE': 'Medicare Average Sales Price (ASP) for Medicare Part B Drugs', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS Part B Drug', 'FEE_SCHEDULE_VERSION': 'then-current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}, {'FILE_NAME': '2014-01-01 COMM PPO - PeaceHealth Multi TIN - Facility and Prof.txt', 'SERVICE_TERM': 'Medicare Part B Drugs (including Injectables and Cancer Drugs)', 'CARVEOUT_IND': 'N', 'REIMB_TERM': 'One hundred thirty percent (130%) of the then-current Medicare Average Sales Price (ASP) for Medicare Part B Drugs. In the event there is no Medicare ASP for a certain prescription drug, reimbursement will be based on the Wholesale Acquisition Cost (WAC).', 'LESSER_OF_IND': 'N', 'GREATER_OF_IND': 'N', 'AARETE_DERIVED_REIMB_METHOD': 'Fee Schedule', 'UNIT_OF_MEASURE': '', 'REIMB_FEE_RATE': '', 'REIMB_PCT_RATE': 100, 'NOT_TO_EXCEED_IND': 'N', 'DEFAULT_IND': 'Y', 'FEE_SCHEDULE': 'Medicare Average Sales Price (ASP) for Medicare Part B Drugs', 'AARETE_DERIVED_FEE_SCHEDULE': 'CMS Part B Drug', 'FEE_SCHEDULE_VERSION': 'then-current', 'AARETE_DERIVED_FEE_SCHEDULE_VERSION': 'current'}]\n"
|
||||
]
|
||||
}
|
||||
],
|
||||
"source": [
|
||||
"from src.investment.one_to_n_funcs import get_methodology_breakout\n",
|
||||
"\n",
|
||||
"reimbursement_primary_answers = labels_df_unique_rows[[\"CONTRACT_FILE_NAME\", \"SERVICE_TERM\", \"CARVEOUT_IND\", \"REIMB_TERM\"]].to_dict(orient='records')\n",
|
||||
"reimbursement_primary_answers = labels_df_unique_rows[[\"FILE_NAME\", \"SERVICE_TERM\", \"CARVEOUT_IND\", \"REIMB_TERM\"]].to_dict(orient='records')\n",
|
||||
"predictions_list = []\n",
|
||||
"\n",
|
||||
"for reimbursement_primary in reimbursement_primary_answers:\n",
|
||||
" filename = reimbursement_primary[\"CONTRACT_FILE_NAME\"]\n",
|
||||
" filename = reimbursement_primary[\"FILE_NAME\"]\n",
|
||||
" methodology_breakout_answers = get_methodology_breakout([reimbursement_primary], filename)\n",
|
||||
" print(reimbursement_primary)\n",
|
||||
" print(methodology_breakout_answers)\n",
|
||||
@@ -585,34 +192,27 @@
|
||||
},
|
||||
{
|
||||
"cell_type": "code",
|
||||
"execution_count": 23,
|
||||
"execution_count": 6,
|
||||
"metadata": {},
|
||||
"outputs": [],
|
||||
"source": [
|
||||
"# Remove rows where 'AARETE_DERIVED_REIMB_METHOD' value is \"Medicare Member Cost Share\"\n",
|
||||
"predictions_df = predictions_df[predictions_df['AARETE_DERIVED_REIMB_METHOD'] != \"Medicare Member Cost Share\"]\n",
|
||||
"import src.postprocessing_funcs\n",
|
||||
"\n",
|
||||
"# Standardize 'AARETE_DERIVED_REIMB_METHOD' values\n",
|
||||
"# Copy AWP, ASP, WAC to AARETE_DERIVED_FEE_SCHEDULE column for the corresponding row\n",
|
||||
"medrx_fee_schedule_values = ['AWP', 'ASP', 'WAC']\n",
|
||||
"predictions_df.loc[predictions_df['AARETE_DERIVED_REIMB_METHOD'].isin(medrx_fee_schedule_values), 'AARETE_DERIVED_FEE_SCHEDULE'] = predictions_df['AARETE_DERIVED_REIMB_METHOD']\n",
|
||||
"\n",
|
||||
"# Convert AARETE_DERIVED_REIMB_METHOD values [AWP, ASP, WAC] to 'MedRx'\n",
|
||||
"predictions_df['AARETE_DERIVED_REIMB_METHOD'] = predictions_df['AARETE_DERIVED_REIMB_METHOD'].replace({'AWP': 'MedRx', 'ASP': 'MedRx', 'WAC': 'MedRx'})"
|
||||
"predictions_df = src.postprocessing_funcs.remove_update_reimbursement(predictions_df)"
|
||||
]
|
||||
},
|
||||
{
|
||||
"cell_type": "code",
|
||||
"execution_count": 9,
|
||||
"execution_count": 7,
|
||||
"metadata": {},
|
||||
"outputs": [
|
||||
{
|
||||
"data": {
|
||||
"text/plain": [
|
||||
"(278, 16)"
|
||||
"(5, 16)"
|
||||
]
|
||||
},
|
||||
"execution_count": 9,
|
||||
"execution_count": 7,
|
||||
"metadata": {},
|
||||
"output_type": "execute_result"
|
||||
}
|
||||
|
||||
Reference in New Issue
Block a user